Aneurysmal Bone Cyst: What to Do When Sclerotherapy Has Not Achieved Healing
Not all aneurysmal bone cysts respond adequately to percutaneous sclerotherapy. When the initial treatment fails to achieve the expected healing of the lesion, a structured protocol defines the next clinical step.
Previous Treatment — Failure Condition
The preceding line involved percutaneous injection of polidocanol (sclerotherapy) under fluoroscopic guidance, administered in multiple sessions. The target for that approach was healing and repair of the bone cyst lesion. When this goal is not achieved, escalation to this next-line protocol is warranted.
Next-Step Approach (Partial Overview)
For lesions that do not respond to sclerotherapy, a surgical intervention at the lesion site is the next option. The full protocol specifies the operative technique and how it is augmented to minimise the risk of local recurrence — those details are within the structured regimen.
Clinical Goal
Local control of the lesion with no recurrence.
References
DOI: 10.7759/cureus.53587
- Curettage should be reserved for lesions that do not respond to sclerotherapy and preferably with a high-speed burr to reduce the chance of local recurrence.
- After intralesional resection of an ABC lesion, a high-speed burr can be used to augment curettage by mechanical disruption of the lesion to the level of the circumscribing bone.
- Gibbs et al. performed curettage with a high-speed burr without the use of any adjuvant on the 34 patients and achieved approximately a 90% control rate after a median follow-up of 7.2 years.
View source ↗